NEW YORK (Reuters Health) – Countless studies have shown that water
fluoridation may prevent tooth decay. However, members of the New
York State Coalition Opposed to Fluoridation believe that the
practice may be unnecessary or even harmful.

Water fluoridation is a threat to health, a threat to democracy–in
the sense of medication without informed consent–and “a huge threat
to the role of honest science, not corporate science, in public
policy,” said Dr. Paul Connett of St. Lawrence University in Canton,
New York. Connett is one of the founding members of the NYS Coalition
Opposed to Fluoridation.

Fluoride, a naturally occurring element, is used to prevent tooth
decay. The compound can be ingested through a fluoridated water
supply and help strengthen teeth during development, and can be
applied directly to teeth via mouth rinses, toothpaste or other
products, according to the American Dental Association (ADA).

Studies conducted as early as the 1930s and the 1940s show that
children who drink fluoridated water will have lower tooth decay
rates than those who drink nonfluoridated water. Recent studies,
including those conducted in countries outside the US, continue to
show similar results, according to the ADA.

The ADA states that “dental decay can be expected to increase if
water fluoridation in a community is discontinued for one year or
more, even if topical products such as fluoride toothpaste and
fluoride rinses are widely used.”

However, study results from a team of Canadian and American
researchers suggest otherwise, according to the antifluoridation
coalition.

A Study Runs Counter To Most

In a study of nearly 6,000 Canadian schoolchildren, Dr. Gerardo
Maupome from the University of British Columbia, and his colleagues
found that the prevalence of cavities decreased in communities that
stopped fluoridating their water. No difference was noted in
communities that continued the fluoridation practice, the authors
report in the February issue of the journal Community Dentistry and
Oral Epidemiology.

“When you have thousands upon thousands of studies, it shouldn’t be
a surprise that occasionally there will be a study that comes out
with an unanticipated result,” John Stamm, dean of the School of
Dentistry at the University of North Carolina-Chapel Hill told
Reuters Health. However, “the vast majority of studies strongly
support the efficacy of properly used water fluoridation.”

As a proponent of the fluoridation practice, Maupome insists that his
results do not prove that the practice is unnecessary.

“Overall, the experience of disease was different in the two
communities–the fluoridated and the nonfluoridated,” Maupome told
Reuters Health. Children in towns that discontinued their water
fluoridation did have a higher rate of dental decay, but as a result
of good access to dental care, ”(it) had become fillings by the time
the children were reexamined,” he explained.

“Water fluoridation still makes sense even for a population with
good access to care and low experience of decay,” Maupome maintains.
Due to the ubiquitous presence of fluoride, however–in mouth rinses,
toothpaste, etc,–the impact of fluoridation “is not as clear cut as
you would have found a half a century ago,” he told Reuters Health.

Group Says Fluoridation Unnecessary

If, as Maupome said, the effects of the cessation of water
fluoridation are not readily detectable due to other existing sources
of the element–or better treatment–the continued practice of
fluoridation is therefore unnecessary, Connett contends.

“You can’t have it both ways,” he said in an interview with Reuters
Health. “Either the fluoridation is absolutely critical to prevent
tooth decay” or it is not.

In most European countries, tooth decay levels are similar to, if not
less than, those in the United States, Connett said, ”and very few
of them fluoridate their drinking water.”

Also, studies conducted in Cuba, Finland and former Eastern Germany
have revealed a decrease in dental decay in communities where
fluoridation was stopped, according to Connett. “So I think they
(water fluoridation advocates) have some real explaining to do.”

Many of the authors cited by Connett, however, used short study
periods, Stamm said. Maupome’s study, for example, took place over a
period of 3 to 4 years.

“The effects of fluoride are cumulative,” Stamm explained. ”When
you cease fluoridation (for a short period) you cannot expect to see
a window where there’s all of a sudden a spike in the dental caries
rate that comes back down after the water fluoridation is
reintroduced.”

Connett’s main worries, however, are the potential dangers of water
fluoridation, such as fluoride accumulation in the bones, “which no
one is studying,” Connett said. He speculates that the high rate of
osteoarthritis as well as some osteosarcomas–cancer of the bone–may
be linked to water fluoridation. A lesser concern is dental fluorosis-
-or tooth discoloration caused by excessive fluoride exposure.

Such apprehensions prompted the Environmental Protection Agency
(news – web sites) (EPA) to request that the National Research
Council (news – web sites)’s Board on Environmental Studies and
Toxicology (BEST) investigate the potential harmful effects of
fluoride.

Their 1993 report, “Health Effects of Ingested Fluoride,” published
by the National Academy of Sciences (news – web sites), shows that
there have been conflicting results about the risk of hip or other
fractures, for example, from fluoride accumulation in the bone. Their
conclusion was that there was not sufficient basis “to recommend
that EPA lower the current standard for fluoride in drinking water.”
However, the board acknowledged that more research is needed in that
area.

Other areas addressed by the board include the effects of fluoride on
the kidney, gastrointestinal and immune systems as well as its
ability to cause cancer. Their report states that fluoride is
unlikely to negatively affect any of these areas, and is most likely
unassociated with any increased cancer risk.

Due to “inconsistencies in the fluoride toxicity database and gaps
in knowledge,” however, the board again recommended further research.

Water Fluoridation Offers Passive Protection

The benefits and effectiveness of water fluoridation continue to
speak for themselves in numerous studies, according to the ADA.
Connett does not disagree with its benefits, yet he contends that
they are “mainly topical, not systemic.”

One might therefore be afforded the same benefits by merely using
fluoride-containing toothpaste, he said.

“Fluoride in toothpaste works very well,” Stamm agreed, ”but it
requires a proactive approach”–ie, buying fluoride-containing
products and using them regularly.

Water fluoridation, on the other hand, is a “passive preventive
method,” he said. “You’re getting your fluoride without any effort,
through the consumption of the public water,” Stamm explained.
“This is why it’s such a wonderful method for helping all people in
society regardless of their economic standing.”

And current studies continue to reinforce the usefulness of
fluoridated water in preventing tooth decay. A UK-based study
published in the January issue of the British Dental Journal shows
that children in towns that began fluoridating water in 1987 had
lower rates of tooth decay than youngsters in one town that remained
fluoride-free.

The study was conducted by Dr. Margaret M. Gray, a UK consultant in
dental public health, and Dr. J. Davies-Slowik of Westhill Clinic in
the UK.

“Fluoridation works;” Gray told Reuters Health in an interview.
“Children in the poor parts of Dudley district who used to have poor
teeth, have (since fluoridation of their drinking water) better teeth
than the children in the most affluent area (Stourbridge) who do not
have the benefit of fluoridated drinking water.”

“Water fluoridation continues to be a very effective method for
preventing tooth decay for children, adolescents and adults,”
according to an ADA statement.